1. e-health information access patient-centric connected community Joann Kern, RN, BSN Vice-President, Clinical Strategy Rita D. Zielstorff, RN, MS Chief Nursing Officer Changing Expectations in Patient-Provider Communications

2. What We’ll Talk About The Market Demand for Providing Secure Messaging Features and Functions of Patient-Provider Communication Applications Issues in Providing Patient-Provider Communication Impact on Patient-Provider Relationships © 2005

3. What We’ll Talk About Return on Investment for Patient-Provider Messaging Systems How Patient-Provider Messaging Can Support an Organization’s Goals How Patient-Provider Messaging relates to the Personal Health Record, the Electronic Health Record, and Quality of Care

4. Market Demand for Patient-Provider Messaging Approximately 2/3 of U.S. population has access to the Internet Of these: About 80% have used the internet recently for health-related matters 90% would like to use the internet to communicate with their providers online 55% would choose health plans or physicians who offered online service 37% would even pay for the service HarrisInteractive 2002

5. What Do Online Patients Want? Get health reminders84% Get personalized info after doctor visit81% Ask questions when no visit necessary77% Make appointments71% Renew prescriptions71% Get lab results70% HarrisInteractive 2000, 2002

6. The Unmet Need Only about 20% of physicians offer online patient- provider messaging »Manhattan Research, 2003

7. Features and Functions of Patient Communication Applications Patient Messaging General text messaging Structured message types E-Consultation (e-Visits) Moderated Chat rooms Forward lab results Send patient education materials Send forms, questionnaires

8. Features and Functions of Patient Communication Applications Patient Portal Functions Access to Medical Record Ability to maintain Personal Health Record Health Management Tools such as smoking cessation, weight management, etc. Shared Provider/Patient record Access to vetted health information, health news, etc. Access to policies, health team credentials, etc. Help function

9. Why Don’t More Providers Offer the Service? Risk Reimbursement Security and Confidentiality Technology Impact on Personal Time Impact on Staff Time and Office Workflow

10. Risk Guidelines to mitigate risk have been developed E-Risk Working Group for Healthcare Federation of State Medical Boards Model Guidelines SCPIE Some examples: Develop policies, get informed consent from patients Make sure patients have been authenticated Incorporate all messages into patient’s medical record, whether electronic or paper

11. Reimbursement Most online messaging is not reimbursed, as telephone communication is not reimbursed May be the biggest barrier to more widespread adoption Some promising developments: Some insurers now reimburse for online consultations Some health plans charge patients to subscribe, then reimburse physicians Some physicians charge patients privately ACP has made policy recommendation for Medicare reimbursement

12. Security and Confidentiality Biggest reason for patient reluctance Solutions: Use SECURE (encrypted) communication service Make sure all servers are behind firewalls Require username and password for access Ensure that patients are authenticated before offering username and password

13. Technology Wide array of choices Some expensive, some not Examples: Medem - secure messaging portal, free with “sponsor” logos on web page, otherwise $30/mo RelayHealth - secure messaging portal, $49.95/mo Healthvision - Organization- or IPA-based, with or without EMR functionality, $30,000 implementation fee, then $24/physician/mo Epic MyChart - Organization-based, shared medical record with messaging See California HealthCare Foundation Report, 2003

14. Impact on Personal Time and Office Workflow Experience doesn’t support the fears Some report 1 message per 100 users per MONTH Some report 1-2 messages per 100 users per DAY Staff generally positive, after time Staff report that online messages take less time One study of content of messages: Brief, focused and appropriate Only half of messages had to be routed to physician

15. Impact on Patient-Provider Relationships Some patients feel online messaging supports a better relationship with their physician Some physicians feel that it encourages trust However, some patients would only use it for administrative matters Some physicians worry that glitches would harm relationship Usually, physicians who are users become strong proponents

16. Return on Investment Depends on cost of implementing and maintaining the technology Depends on whether you are being reimbursed for services Online consultations - private pay or insured Patient subscription fees Depends on whether office workflow is optimized Depends on whether intangible returns are counted Patient satisfaction, loyalty, retention Patient recruitment Staff satisfaction, retention

17. Enterprise Patient-Provider Messaging: Engaging the new Healthcare Consumer More consumer control of where their healthcare dollars are spent Health care enterprises (Hospitals, clinics, ambulatory care centers) are increasingly competing for key consumer markets Consumer demands and expectations are growing

18. Enterprise Patient-Provider Messaging: Engaging the new Healthcare Consumer Health care enterprises (Hospitals, clinics, ambulatory care centers) are responding to these increased demands… Web presence is moving from static “brochure-ware” to more interactive services – capturing the attention of the casual health info seeker and build relationships Enterprises add health information and interactive health management tools such as health risk assessments to create a one-to-one relationship with that consumer Then add personalized e-health services - PHRs and direct Patient-Provider Messaging with business units

20. Engaging the informed health care consumer….

21. Patient-Provider Messaging and the Personal Health Record: Key to the EHR How important is the patient’s personal health record to the global Electronic Health Record? HIMSS Electronic Health Record Definitional Model Department of Health and Human Services and the office of the Healthcare Information Technology “Strategic Framework” IOM Committee on Data Standards for Patient Safety “Key Capabilities of an Electronic Health Record System”

22. Patient-Provider Messaging and the Personal Health Record: Key to the EHR

23. IOM “Key Capabilities of an Electronic Health Record System” defines EHR requirements in care Settings – 4 th Care Setting (Care in the Community) calls for PHR inclusion. Recommendations also refer to enabling communication flows between providers and patients “Effective communication among health care team members and other care partners and with patients is critical to the provision of quality health care.”

24. Summary There is strong patient demand for secure messaging, but only a fraction of providers are currently offering the service There are low-cost products available Providing this service can be a competitive advantage, for the individual practitioner or the organization ROI can be positive

25. Summary, cont. Messages can be a valuable information source for the electronic medical record Messaging can positively influence quality of care Healthcare enterprises can use Patient-Provider Communication to grow relationships and improve service Patient-Provider Communication is increasingly becoming part of the PHR and therefore, part of a global patient-centric, community EHR

26. And finally… There are many resources available to you for further learning – check them out! Thank you!

27. e-health information access patient-centric connected community Rita D. Zielstorff, RN, MS Chief Nursing Officer rzielstorff@healthvision.com Questions? Joann Kern, RN, BSN Vice President, Product Strategy jkern@healthvision.com